| Objectives: To assess the effectiveness of palliative care in China through systematic review; to summarize the current status; to explore the gaps of Chinese palliative care in organization, implementation and evaluation; to propose feasible suggestions, and to provide theoretical evidences for standardized palliative care in China.Methods: A systematic search of Pubmed, Embase, Medline, Web of Science, Science Direct, CNKI, VIP and Wan Fang was carried out. The search period was restricted from January 2000 to January 2016. The literature of randomized controlled trials(RCT) on the effectiveness of palliative care were selected.The Cochrane Handbook for Systematic Reviews of Interventions was used to assess the quality of studies met the inclusion criteria. The participants, practitioners, contents, outcome measurement and effects were systematically reviewed. The impact of palliative care on quality of life, psychological status, Patient Satisfaction were analyzed by meta-analysis.Results:1. A total of 40 randomized controlled trials were identified after athorough literature search. All of the included studies were Grade B.2. The sample size was 3407, of which 90.3% were about cancer patients, 7.3% were about non-malignant diseases patients and 2.3% were about family members of patients. 94.3% of the participants were from inpatient, while others were from community. The practitioners included nurses(92.3%), doctors(53.8%), patients dependents(15.4%), psychologists(12.8%), rehabilitation therapists(5.12%), social workers(5.12%) and volunteers(5.12%). Only 5% practitioners received specialized training and22.5% of them were the multidisciplinary team of palliative care. The content was comprehensive, of which the main measures were symptom control(85%), psychological nursing(80%), family support(47.5%), 45% combined with basic nursing and 42.5% combined with death education. The outcome measurements included quality of life,psychological status, symptom control, patient satisfaction and others.3. Palliative care for cancer patients(1)Quality of Life:at 2 weeks,[SMD=0.67,95%CI(-0.38,1.72),P=0.21];at 3 weeks,[SMD=1.42,95%CI(0.31,2.54),P=0.01];at 4 weeks,[SMD=4.50,95%CI(2.17,6.82),P<0.00001];at 8 weeks,[SMD=1.91,95%CI(0.13,3.70),P=0.04];at12 weeks, [ SMD=4.74, 95%CI( 2.67, 6.80), P < 0.00001 ].(2)psychological status: Anxiety:at 2 weeks,[SMD=-0.53,95%CI(-1.10,0.05),P=0.07];at 4 weeks,[SMD=-0.90,95%CI(-1.28,-0.52),P<0.00001];at 8 weeks,[SMD=-1.01,95%CI(-1.22,-0.79),P<0.00001];at 12 weeks,[SMD=-1.78,95%CI(-2.00,-1.55),P<0.00001].Depression:at 2 weeks,[SMD=-1.00,95%CI(-2.08,0.09),P=0.07];at12 weeks,[SMD=-1.55,95%CI(-2.72,-0.38),P<0.0001].(3)symptom control: The results of descriptive analyses revealed that the experimental group has more higher trend than control group in alleviating pain and cancer related fatigue.(4)patient satisfaction: The result from the descriptive analysis shows that in patient satisfaction the experimental group is higher than those in control group.4. Palliative care for non-malignant diseases patients: The result from the descriptive analysis shows that in quality of life, psychological status,symptom control and patient satisfaction, the experimental group is higher than those in control group.Conclusions:1.Although palliative care has been paid extensive attention, the quality of the included studies was class B. Selection bias, performance bias, measurement bias, attrition bias and reporting bias were existed.2.The main participants of palliative care were cancer patients, while the attention paid for non-malignant diseases patients and patients’ family members was little. In addition, the sample size of included studies was small and with weak representation compared the existing cases.3.For cancer patients, palliative care could produce short-term effects on enhancing their quality of life, improving anxiety and depression,alleviating cancer-related symptoms and improving patient satisfaction.4.For non-malignant diseases patients, there were limited studies showed that palliative care had some positive effect on quality of life,psychological status, symptom control and patient satisfaction, but further and larger-scale randomized controlled trials of palliative care for non-malignant diseases patients are needed.5.Only 1 trials chose patients’ family members as the object of study,thus the current evidence cannot reach a precise conclusion about the effectiveness of palliative care on family members of patients. |
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